- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.72 / $3,666.78 / $7,119.04
| Facility | | $1,194.72 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.86 / $856.26 / $3,267.20
| Professional | | $594.86 | $856.26 | $3,267.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.74 / $1,369.47 / $5,163.00
| Facility | | $752.74 | $1,369.47 | $5,163.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,104.64 / $1,471.64 / $1,865.65
| Facility | | $1,104.64 | $1,471.64 | $1,865.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |